Objective: This study aimed to analyze potential drug interactions in prescriptions for patients concurrently using psychotropic and cardiovascular medications, investigating the relationship between severe interactions and adverse drug events. Methods: A retrospective, cross-sectional, descriptive study was conducted at a university hospital in Teresina, Piauí. Data were collected between March and August 2024, covering patients admitted from June 2021 to December 2023. Adults aged 18 years or older, hospitalized for at least five days and receiving both cardiovascular and psychotropic medications, were included. Potential drug interactions were identified using the “Interactions Checker” tool from Drugs.com® and classified by severity. Prescriptions containing severe interactions were analyzed using the Global Trigger Tool to detect potential adverse event markers, and the causal relationship was assessed with the Naranjo Algorithm based on medical records. Results: The sample consisted mostly of male patients, with a mean age of 63 years. Among the 150 prescriptions analyzed, 39 psychotropic medications and 35 cardiovascular medications were identified, with an average of 5.52 drugs per prescription. The most frequently prescribed psychotropic classes were antipsychotics, anxiolytics, hypnotics, and sedatives; opioid analgesics; and antiepileptics. Among cardiovascular medications, beta-blockers, lipid-lowering agents, and renin–angiotensin system inhibitors were the most common. A total of 1,040 coadministration scenarios were identified, of which 59.6% were classified as moderate and 6.7% as severe. Amiodarone and morphine were the medications most frequently involved in severe interactions, including simvastatin–morphine and carvedilol–morphine combinations. Adverse event markers were detected in six patients, and a possible causal relationship was observed for combinations of morphine with carvedilol or simvastatin and amiodarone with fentanyl or escitalopram. Conclusion: The study found a high incidence of moderate potential interactions in cardiac patients using psychotropic medications and identified a possible causal link between severe interactions and adverse drug events in four patients, reinforcing the need for vigilant pharmacovigilance.
In recent decades, African cities have been confronted with series of floods linked to rapid urbanisation, intensification of heavy rains and the failure of the storm drainage system. Developing tools to characterise floods and reduce their impact is essential to facilitate decision support in a complex and vulnerable context. This study, conducted in the urban periphery of the Dakar metropolitan area, aims to propose a fine resolution (5 m) model of flows and overflows of rainwater drainage network in a pilot area. Two methodological steps are combined to achieve this objective: (1) the construction of the urban drainage topology to reconstitute the water drainage directions, taking into account the buildings, artificial channels and retention basins, using algorithms developed for this purpose, (2) simulations of the flows in real time or in project mode, using a parsimonious spatial model adapted to the local context, coupling a hydrological model (SCS-LR) on the scale of small basins with a hydraulic model (kinematic wave) for the propagation through the hydrological network. The former ensures the speed of the calculation, and the latter provides precise information on the behaviour of the network during a rainfall event. The overflow points of the network are detected by the difference between the maximum flow and the capacity of the network to evacuate floods. This modelling provides sufficiently informative simulations to guide the deployment of emergency services in the field, in real time, or to evaluate the efficiency of infrastructures in project mode, in a context of limited data. The model also provides boundary conditions for applying more complex hydraulic models to determine the impact of overtopping on limited areas.
BackgroundAnal canal squamous cell carcinoma (SCC) is a relatively uncommon neoplasia, and it is mostly a local-regional cancer, of low metastatic potential (only 15%), resulting in cure in most cases treated with definitive chemoradiation. On the other hand, its incidence has been steadily increasing over the last decades, which makes it an important public health problem. In an effort to provide surgeons and oncologists who treat patients with anal cancer with the most updated information based on the best scientific evidence, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guideline for the management of anal canal SCC, focused on the main topics related to daily clinical practice. ObjectivesThe SBCO developed the present guidelines to provide recommendations on the main topics related to the management of anal canal squamous cell carcinoma (SCC) based on current scientific evidence. MethodsBetween October 2022 and January 2023, 14 experts met to develop the guidelines for the management of anal canal cancer. A total of 30 relevant topics were distributed among the participants. The methodological quality of a final list with 121 sources was evaluated, all the evidence was examined and revised, and the management guidelines were formulated by the 14-expert committee. To reach a final consensus, all the topics were reviewed in a meeting that was attended by all the experts. ResultsThe proposed guidelines contained 30 topics considered to be highly relevant in the management of anal canal cancer, covering subjects related to screening recommendations, preventive measures, tests required for diagnosing and staging, treatment strategies, response assessment after chemoradiotherapy, surgical technique-related aspects, and follow-up recommendations. In addition, screening and response assessment algorithms, and a checklist were proposed to summarize the important information and offer an updated tool to assist surgeons and oncologists who treat anal canal cancer and in providing the best care to their patients. ConclusionThese guidelines summarize recommendations based on the most current scientific evidence on relevant aspects of anal canal cancer management and are a practical guide to help surgeons and oncologists who treat anal canal cancer make the best therapeutic decisions.
CONTEXT:Photobiomodulation therapy (PBMT) has been widely used to improve strength, fatigue resistance and increase muscle mass in healthy individuals. These effects could help critically ill patients admitted to intensive care units (ICUs) who show reduced mobility and muscle strength. ICU-acquired weakness lessens overall health and increases the patient's length of stay in the ICU. OBJECTIVE:This study evaluated the effects of PBMT using low intensity light-emitting diodes (LEDs) on the mobility and muscle strength (functional capacity) and length of stay of patients admitted to hospital ICU. METHODS:This randomized, triple-blind, sham-controlled trial was conducted in a hospital ICU. Sixty patients were randomly assigned to two equal groups: (a) PBMT and (b) Sham. PBMT was applied daily to patients until their discharge from the ICU, using a flexible neoprene array of 264 LEDs (120 at 635 nm, 1.2 mW each; 144 at 880 nm, 15 mW each) for 90s (207.36 Joules) at each site. Ten sites were located bilaterally on the thighs, legs, arms, and forearms ventrally and dorsally, 15 min totaling 2,073.6 Joules per session. Outcomes were length of stay (in h) until discharge from the ICU, muscle strength by the Medical Research Council (MRC) score and handgrip dynamometry (HGD), patient mobility by Intensive Care Unit Mobility Scale (IMS) and the Simplified Acute Physiology Score 3 (SAPS 3) for predicting mortality of patients admitted to the ICU. RESULTS:PBMT reduced the average length of stay in the ICU by ~30% (p = 0.028); increased mobility (IMS: 255% vs. 110% p = 0.007), increased muscle strength (MRC: 12% vs. -9% p = 0.001) and HGD (34% vs. -13% p < 0.001), and the SAPS3 score was similar (p > 0.05). CONCLUSION:The results suggest that daily PBMT can reduce the length of stay of ICU patients and increase muscle strength and mobility.
Essential tremor (ET) is identified as the most prevalent movement disorder, primarily characterized by tremors in both upper extremities. The spectrum of surgical options for ET includes gamma knife radiosurgery (GKRS) and other stereotactic radiosurgery (SRS) modalities. Despite the limitations of these options, SRS is deemed an essential and indispensable approach. Our research aimed to assess the safety and efficacy of SRS, such as GKRS, on tremor control and the spectrum of associated adverse events in the treatment of ET, also focusing on long term outcomes of the procedure. We systematically conducted an extensive search across esteemed databases, which included PubMed, Cochrane Library, Embase, and Web of Science. We included studies involving individuals diagnosed with ET who had undergone GRKS treatment. A proportional rate was used to evaluate the outcomes in a 95
